Provider Demographics
NPI:1558431643
Name:KANKARIA, RAVINDRA S (OD)
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:S
Last Name:KANKARIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:RAVINDRA
Other - Middle Name:S
Other - Last Name:KANKARIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5164 ALDINE MAIL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-3802
Mailing Address - Country:US
Mailing Address - Phone:281-449-7400
Mailing Address - Fax:281-449-8020
Practice Address - Street 1:5164 ALDINE MAIL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-3802
Practice Address - Country:US
Practice Address - Phone:281-449-7400
Practice Address - Fax:281-449-8020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4103T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU18429Medicare UPIN